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Fever in children: How can you reduce a fever?

Created: ; Last Update: November 17, 2016; Next update: 2019.

When children have a fever, they don't always need to be given medication to lower it. But it can be a good idea to treat the fever if they are feeling extremely unwell or the fever is very high.

It isn’t always clear whether the child's symptoms are being caused by the fever or by an underlying illness. So lowering the fever won't necessarily make them feel better.

There are basically two ways to lower a fever: using medication or applying a cooling treatment from outside the body Some parents hope that they will be able to prevent febrile seizures with medication. But there is a lack of good research on whether fever-lowering medication can actually prevent febrile seizures.

Many parents also try homeopathic products, including aconitum D12, belladonna D12 or chamomilla D12. But there is no scientific proof that these homeopathic treatments are at all effective.

What medications can be used?

Fever-reducing medication inhibits the body’s production of substances that increase body temperature, such as prostaglandins. Medications that are appropriate for children include acetaminophen (paracetamol) and ibuprofen. These are available in the form of suppositories or syrup and – for older children – tablets and soluble granules for fizzy (effervescent) or hot drinks. Acetaminophen and ibuprofen are the most commonly used medications for children with a fever.

Acetylsalicylic acid (ASA – the drug in medications like Aspirin) should only be used in children and teenagers if the doctor prescribes it. This is because it can cause a rare but dangerous side effect called Reye’s syndrome.

The amount of acetaminophen (paracetamol) or ibuprofen a child is allowed to take depends on their age and body weight. If the child is less than six months old, it is important to ask a doctor at first. When giving these medications, you need to wait a certain amount of time between doses (6 to 8 hours) too. More detailed information can be found in the package insert. If you still have any questions, you can also ask your doctor or pharmacist.

Acetaminophen (paracetamol) and ibuprofen have similar adverse effects. But acetaminophen has a longer history of use in children, so more is known about its possible side effects. These include diarrhea and vomiting. At higher doses it can damage the liver and kidneys. That is why it's so important to use the right dose and also make sure you wait long enough before giving the next dose.

If the child takes acetaminophen or ibuprofen and still has a fever after about four days, it is generally a good idea to seek medical advice.

Does using both medications have any advantages?

There is not enough research to be able to say whether taking both acetaminophen (paracetamol) and ibuprofen at the same time has any advantages. A few studies suggest that combining the two medications lowers fever more effectively than just taking one of them. Four hours after taking both medications, somewhat fewer children had a fever again or still had a fever. But there is only little research on the possible side effects of this treatment approach. It is also thought that the risk of overdosing is higher if you use a combination of the two medications.

Sometimes people recommend taking acetaminophen and ibuprofen alternately. But there has not been enough good research to be able to assess the pros and cons of doing this.

Can externally applied approaches help?

These approaches cool the body from the outside without treating the cause of the fever. They include lukewarm or cool wraps or baths, cold drinks and very light clothing. You can also fan the child, dab them with a wet sponge or cloth, or open the window. It is important to always make sure the child feels comfortable, and that he or she is not getting too cold.

Cooling lower legs with wet towels is a popular home remedy. This involves dipping two towels in water – lukewarm water for children, or alternatively cold water for adults. The towels are wrung out a bit and wrapped around each of the child’s lower legs. Dry towels are then wrapped around the wet towels, and the towels are left on for about 10 to 20 minutes. If the child's arms and legs are cold despite their fever, it is better not to cool them in this way.

There are hardly any good studies on whether these kinds of externally applied cooling approaches help lower fever in children.

Sources

  • Meremikwu M, Oyo-Ita A. Physical methods for treating fever in children. Cochrane Database Syst Rev 2003; (2): CD004264.
  • National Collaborating Centre for Women`s and Children's Health, National Institute for Health and Care Excellence (NICE). Feverish illness in children: assessment and initial management in children younger than 5 years. 05.2013. (NICE Clinical Guideline; CG160).
  • Offringa M, Newton R. Prophylactic drug management for febrile seizures in children. Cochrane Database Syst Rev 2012; (4): CD003031.
  • Pereira GL, Dagostini JM, Pizzol Tda S. Alternating antipyretics in the treatment of fever in children: a systematic review of randomized clinical trials. J Pediatr 2012; 88(4): 289-296. [PubMed: 22915173]
  • Wong T, Stang AS, Ganshorn H, Hartling L, Maconochie IK, Thomsen AM et al. Combined and alternating paracetamol and ibuprofen therapy for febrile children. Cochrane Database Syst Rev 2013; (10): CD009572. [PubMed: 24174375]
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK279453

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